Routine inferior mesenteric artery (IMA) embolisation is unnecessary before endovascular aneurysm repair (EVAR)

Published:November 02, 2022DOI:
      This paper is only available as a PDF. To read, Please Download here.



      A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy/centre A) and leaving the IMA untouched (strategy/centre B).

      Design and methods

      Patients were treated with EVAR in two centres during 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were reintervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR-related reintervention, sac enlargement, aneurysm rupture and open conversion rates.


      Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed on 164 (41.4%). The corresponding figures for strategy B were 337 patients with 280 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean follow-up time was 70 months for strategy A and 68.2 months for strategy B. The reintervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .291), with no significant difference in the rate of reinterventions to occlude a patent IMA (2.0% and 4.7%, respectively, p=.039). The EVAR-related reintervention rate was similar regardless of the strategy (24.1% and 24.6%, respectively, p = .931). Significant sac enlargement was seen in 20.3% of the cases with strategy A and in 19.6% with strategy B (p = .821). The rupture and conversion rates were 2.5% and 2.1% (p = .684) and 1.0% and 1.5% (p=.398), respectively.


      The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should, therefore, be abandoned.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Vascular and Endovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect